WHECTY Membership

WELCOME TO WHECTY

Please fill out the form below to sign up for WHECTY membership for the 2022-2023 programming year.

The cost is $36 for WHC members; $54 for anyone else.

Membership is open to teens in grades 8-12.

WHECTY Membership includes a discount on many events, a WHECTY merchandise item and supports our programming throughout the year.

Please contact Ira Miller with any questions.

PARENT CONTACT INFO

PARENT 1 First Name

PARENT 1 Last Name

PARENT 1 Phone Number

999-999-9999

PARENT 1 Email Address

This email address will receive the payment confirmation for this form

PARENT 2 First Name

PARENT 2 Last Name

PARENT 2 Email Address

PARENT 2 Phone Number

999-999-9999

Is your family a member of WHC?

Would you like someone to contact you with more information about membership?

yesno

TEEN INFORMATION

Teen First Name

Teen Last Name

Teen Phone Number

(if you don't have a cell phone please enter 111-111-1111)

Teen Email Address

Grade in school

8th9th10th11th12th

School

Preferred pronouns:

please write your preferred pronouns here:

Subtotal

ADDITIONAL TEEN INFO

Would you like a WHECTY Board member to reach out directly to the teen listed above?

yesno

Anything else we should know? Feel free to share information about the teen listed, programs that may be of interest or any questions that you have. (Note: this section will be seen by WHC's adult staff only!)

TOTAL COST

Subtotal

Do you have a discount code?

Discount Code

Total

Refund Policy

PAYMENT

First Name on Card

Last Name on Card

Credit Card Number

Expiration Month

Expiration Year

CVV

Billing Street

Billing City

Billing State

Billing Zip Code

Click SUBMIT only once to avoid being charged multiple times.

Publicly Hidden Fields

Payment Section

Hide Payment Info

Hidden

Portal Pre-fill Fields

Account ID

Contact ID

Congregation Connect Fields

OutreachID

DesignationID

Auth.net Connector Billing Info

Auth.net Payment Info

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